Provider Demographics
NPI:1164670303
Name:WALTON, PATTIE N (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATTIE
Middle Name:N
Last Name:WALTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SEA CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1106
Mailing Address - Country:US
Mailing Address - Phone:631-650-5964
Mailing Address - Fax:631-650-5964
Practice Address - Street 1:445 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2735
Practice Address - Country:US
Practice Address - Phone:718-963-0800
Practice Address - Fax:718-534-5221
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400461-1163W00000X
NYF334488-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse